Interview with Gait and Exercise Experts Drs. Kevin and Heather Vincent

It is a privilege to share additional insight and expertise  from Drs. Kevin and Heather Vincent on the process (and outcome) of their position paper, “Selecting Running Shoes,”  for the American College of Sports Medicine’s  (http://www.acsm.org/docs/brochures/running-shoes.pdf ) The published document was big news for all runners and walkers, as it represented a dramatic change in footwear recommendations.  As I wrote in an earlier Dr. Mark’s Desk essay, “After a generation of sports medicine doctors, podiatrists, coaches, and shoe stores ‘prescribing’ elevated heel, cushioned, and supportive shoes with controlling devices, the science and experience are now finally connected to help directly benefit runners and walkers. The ACSM has refined their position statement to align with ours at Two Rivers Treads in Shepherdstown, WV.”

Kevin and Heather make a dynamic duo who’ve successfully bridged clinical and research work. Both are affiliated with the University of Florida in Gainesville with a human performance lab. Kevin is an M.D. and PhD, and his wife, Heather is a Ph.D in Exercise Physiology. They have over 65 peer-reviewed publications and 100 published abstracts in a variety of exercise related areas including biomechanics, functional movement, general exercise prescription, and obesity.  They met in graduate school and have been working together for over 20 years as research partners.  The main focus of their work is to improve function — both physically and psychologically. Both have been involved in multiple lines of research with common overlap. Their current research projects include examining gait in runners, as well as working with patients with knee arthritis, and patients with obesity.  Although these populations are quite different, what ties them together is using exercise, diet, and biomechanics to improve their health and function. –Dr. Mark

Q: What prompted you to co-write this article for ACSM?

A: This was a topic proposed by Heather to their committee, as she is a member of it. At the time, she did not know that it had been written before, but once she saw the prior version, she quickly noted that it was full of the same old information that keeps putting runners in the wrong shoe.  She was inspired to propose the topic because we consistently see runners put into bulky stability shoes (with or without orthotics) by running shoe stores or {healthcare} providers who do not have the training on running mechanics and how to properly recommend a shoe for runners

Q: When was the last official ACSM statement on this topic?

A: 2011.

Q: What were ACSM recommendations at that time?

 A:  It revolved around picking a shoe based upon foot type, and more to control how the foot responds to the ground as opposed to just protecting the foot from the ground as we advocate.

Q: Why did the ACSM decide to revise their position now?  

A: The decision was made by the committee chair who felt that Heather made a compelling case for why it needed to be re done

Q: Can you further elaborate on the “old” logic about “putting runners in the wrong shoe?”

A: The common practice that we saw is that providers look either at foot type, or at the fact that the runner pronates and then tells them that they need a stability shoe.  Other common practices are having an element of plantar fasciitis or tibialis posterior tendonitis and determining that the runner needs orthotics and a high-arched stability shoe. There is a general lack of awareness that many of these problems can be treated with improved hip strength, dynamic stability training, and improved foot-intrinsic muscle strength. Instead, the focus is to stabilize the foot and put it in a “cast” to prevent motion.

Q: Can you briefly describe your daily practice and work environment?

A: We have a practice that spans the continuum from clinical care, to research, to our leading the University of Florida Sports Performance Center in The Department of Orthopaedics and Rehabilitation. We both see patients with a vast array of musculoskeleatal complaints and fitness backgrounds, but Kevin specializes in runners and lower extremity.  These runners range from novice runners who have just started running through people that have been running over 30 years.  Despite level of experience, there can be common themes that cross genders such as poor hip and core strength, lack of dynamic stability, inappropriate volume changes, not fully understanding how to select the correct shoe, and how to properly accomplish gait retraining.

We also bring patients into the University of Florida Running Medicine program through the Sports Performance Center (SPC). Typically, these patients have been injured in the past, are currently injured, or want to avoid injury. We analyze their gait, strength, shoes, and training. We then help them become a healthier, and hopefully happier runner by making appropriate recommendations and adaptations.  Through the SPC, we can have them work with one of our therapists who specializes in working with runners, or we can get them connected with other specialties they may need such as sports nutrition.  Finally, we continually have research projects related to running that also serves as a great way for people to get involved with our program. Our focus is to keep runners on the road, running for life, and we try to prevent injuries.

Q: How is your gait lab set up and what are its main features?

A:  The gait lab is about 3,000 square feet. It has a 15 camera 3-D motion analysis system, AMTI dual-belt, dual-force-plated treadmill, a 27-foot gait mat, K4 gas analyzer system, telemetric EMG, 2 force plates in the floor. We have a total of 3 treadmills (including the one with the force plates,) one is also free standing and the third is a Quinton which is attached to an ECG machine and metabolic cart for VO2 max and lactate threshold tests. We have a senior biomedical engineer who is amazing with image processing, programming and anything else we need. Heather directs the lab. We also have doctoral students, interns, Masters students and research coordinators.

Q: You both have an impressive history of research. Can you elaborate?

A: We actually met in graduate school and have been working together for over 20 years as research partners. We each have over 65 peer-reviewed publications and over 100 published abstracts.  The main focus underlying all our research work is to improve functional ability and psychological health while minimizing pain. We each have multiple lines of research with a common overlap. We currently have four research projects examining gait in runners, but we also have other lines working with patients with knee arthritis as well as patients with obesity. Although the populations are quite different, what ties them together is using exercise, diet, and biomechanics to improve their health and function and mental outlook.

Q: How have your positions on running and gait evolved over the last few years?  

A: Our research as well as the data being generated by other well-known researchers in this area (Kerrigan, Davis, Hamill, Heiderscheit, Lieberman, etc) has evolved our thought on running biomechanics and training. By working with Casey and Bob Wilder at the University of Virginia  as well as assimilating the work of the others listed here, we have evolved from traditional thoughts on running and running shoes to advocate a more “natural” form of running whereby the shoes don’t dictate how you run and how your foot responds to the ground. We have noticed that when we film runners in a thick-soled shoe, they drive their heel into the ground, but if I take their shoes off and make them run down the street in their socks, they instinctively adopt a light, efficient mid/forefoot strike. I then ask them, “Why do you run differently just because we put a shoe on?” The body instinctively knows how to run to minimize forces, so why does it change because of the shoe? The simple answer is because the shoe protects runners from poor gait choices by minimizing the pain of the heel strike, but causes multiple other gait problems that don’t become apparent until overuse injuries occur.

Q: What has been the overall reaction to “Selecting Running Shoes?”

A: We had some initial resistance from a couple members of the committee, but since the release of the article, we have had a positive response from people that really wanted this type of information. We now give this to our runners in clinic and the SPC. They appreciate the information. Most are a bit dismayed to find out they picked the wrong shoe and that most shoe store employees don’t really understand gait, feet or shoes. But when the principles are explained, they really seem to get it.

Q: Has there been any response from the major shoe companies?

A: None

Q: Is there any consensus on the part of orthopedists, physical therapists, athletic trainers, and personal trainers when it comes to making shoe recommendations?

A: No real consensus. My experience is that those organizations, for the most part, perpetuate the commonly held misguided beliefs when it comes to shoes for the past 30 years

Q: What events or information could encourage more people in the general public to accept the new ACSM recommendations?

 A:  In the absence of good information, runners will gravitate towards sources that provide the same old misinformation that comes from most running shoe stores, running shoe companies, and other runners. Instead, we need to get information out about how the body is designed to run and the principles concerning how to properly select a shoe – most importantly, not to have a shoe that creates increased risk of injury. When I explain to people how the shoe changes their gait, their force dispersion, and their mechanics, all of which can lead to injuries and degenerative changes, they seem to understand and buy into the concept of a more natural shoe and gait. The toughest issue is how to get our voices heard over the consistent din coming from groups perpetuating the same old misinformation.

Q: Are you both runners?

A: When we met, Heather was the runner and I (Kevin) was a weightlifter who liked intense aerobic activity for overall fitness. Over time, I have become a convert to running when I tried to adopt a healthier lifestyle. I had always done some running as preparation and conditioning for sports, but it did not become my primary source of exercise until 2002. At that time I wanted to lose some of the weight I had from weight training and improve my overall health. Since that time, I have become more avid with running and I do more of a fitness-based resistance-training program. I have also been an injury-free since I converted from a rear-foot strike to a forefoot strike with a minimal shoe several years ago.  The change in my gait and shoes has been great. Before I made the change, after long runs, my knees would ache and I would have to ice them or submerge in cold water. Now I feel just fine!